• Emily M Olson, Samuel D Falde, Abigail K Wegehaupt, Eric Polley, Andrew J Halvorsen, Donna K Lawson, and John T Ratelle.
• Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
• J Hosp Med. 2022 Sep 1; 17 (9): 710-718.

BackgroundMany hospitalized patients do not understand or agree with their clinicians about their discharge plan. However, the effect of disagreement on discharge outcomes is unknown.ObjectiveTo measure the correlation between patient-clinician care agreement and discharge outcomes.DesignA prospective cohort study was performed from September 2019 to March 2020 (Rochester, MN, USA).Setting And ParticipantsInternal medicine patients and their primary clinician (resident, advanced practice clinician or attending) hospitalized from September 2019-March 2020 at Mayo Clinic Hospital. Participants were independently surveyed following hospital day #3 ward rounds regarding the goals of the hospitalization and discharge planning.Main Outcome And MeasuresPatient-clinician agreement for main diagnosis, patient's main concern, and four domains of discharge planning was assessed. Readiness for hospital discharge, delayed discharge, and 30-day readmission was measured. Then, associations between patient-clinician agreement, delayed discharge, and 30-day readmissions were analyzed using multivariable logistic regression.ResultsOf the 436 patients and clinicians, 17.7% completely agreed about what needs to be accomplished before dismissal, 40.8% agreed regarding discharge date, and 71.1% agreed regarding discharge location. In the multivariable model, patient-clinician agreement scores were not significantly correlated with discharge outcomes. Patient-clinician agreement on discharge location was higher for those discharged to home (81.5%) versus skilled nursing facility (48.5%) or assisted living (42.9%) (p < .0001). The agreement on the expected length of stay was highest for home-goers (45.9%) compared to skilled nursing (32.0%) or assisted living (21.4%) (p = .004).ConclusionsPatients and their clinicians frequently disagree about when and where a patient will go after hospitalization, particularly for those discharged to a skilled nursing facility. While disagreement did not predict discharge outcomes, our findings suggest opportunities to improve effective communication and promote shared mental models regarding discharge earlier in the hospital stay.© 2022 Society of Hospital Medicine.

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